STIs

AIDS/HIV

Updated December 2016.

What is HIV and AIDS?

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). The virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or to infants during pregnancy, birth, or breast feeding.

HIV attacks certain types of white blood cells, primarily T4 cells (commonly known as T-cells) and macrophages, which are crucial to the normal functioning of the immune system. The disruption of these cells causes the breakdown in the immune system that characterizes AIDS.

AIDS is an illness that damages a person's ability to fight off disease, leaving the body open to attack from unusual types of cancer and from infections that the body's immune system could ordinarily fight off. These types of infections are known as "opportunistic" infections because they take advantage of a weakened immune system to cause illness. AIDS is not a single disease, but rather a collection of symptoms caused by opportunistic infections and/or cancers. Pneumocystis carinii pneumonia and Kaposi's sarcoma, once a rare type of cancer, have been the most common causes of death in people with AIDS in the US

Is it common?

According to the Centers for Disease Control (CDC), an estimated 1.1 million people in the United States are living with HIV infection, and about 1 in 7 (15%) are unaware of their infection. In 2016, 39,782 people were newly diagnosed with HIV in the US. The annual number of HIV diagnoses declined 5% between 2011 and 2015. In 2016, an estimated 18,160 people were diagnosed with AIDS. Overall, an estimated 1, 232,346 people in the United States have been diagnosed with AIDS. In 2014, 6,721 deaths were attributed directly to HIV.

How is it transmitted?

This virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or parent-to-infant contact. These body fluids have been proven to spread HIV:

Blood

Semen

Vaginal fluid

Breast milk

Other body fluids containing blood

HIV enters the body through cuts in the skin, open sores, tiny tears in the mucous membranes of the mouth, rectum, or vagina, and directly into the blood by a needle. It is generally accepted that the virus is transmitted through direct exposure to contaminated bodily fluids that have not been exposed to the air. HIV is commonly spread by:

Having unprotected sexual intercourse with someone who has the virus.

Getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores.

Sharing needles or syringes with someone who has the virus.

Being deeply punctured with a needle or surgical instrument contaminated with the virus.

Passing from a parent to an infant during pregnancy, birth, or breast feeding.

Receiving transfusions of blood products donated by someone who has the virus (although the risk of transmitting HIV by a screened blood transfusion is practically nonexistent. Since 1985, the US blood supply has been screened for HIV and is believed to be very safe.)

HIV cannot go through unbroken skin. In comparison to the flu and common cold viruses, HIV is actually quite fragile and will die quickly if exposed to air. HIV is not transmitted through:

Insect bites

Human bites

Dry kissing

Saliva, tears, urine, or sweat

Contact with public toilets or drinking fountains

Shaking hands, giving hugs or sharing a cup

In order to assess your risk in intimate activities, consider the continuum of risk below:

Very low risk -- no reported cases due to these behaviors

Masturbation or mutual masturbation

Touching or massage

Erotic massage or body rubbing

Casual kissing

Oral sex on a penis, using a condom

Oral sex on a vulva, using a dental dam

Low risk - rare reported cases due to these behaviors

Deep kissing

Unprotected oral sex

Vaginal sex using a condom

Anal sex with a condom

High risk -- millions of reported cases

Vaginal sex without a condom

Anal sex without a condom

What are the symptoms?

It is possible to be infected with HIV and to transmit the virus without showing symptoms of illness. Many people do not develop any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. They may have symptoms including:

Fever

Headaches

Lack of energy

Enlarged lymph nodes easily felt in the neck and groin

These symptoms usually disappear within a week to a month and are often mistaken for the flu. The only way to determine for sure whether you are infected is to be tested for HIV. The following symptoms may develop after years of being infected with HIV and may signal that the infection has progressed to AIDS:

Rapid weight loss

Deep, dry coughing

Recurring fever or profuse night sweats

Profound and unexplained fatigue

Swollen lymph glands in the armpits, groin, or neck

Diarrhea that lasts for more than a week

Bruising more easily than normal

White spots or unusual blemishes on the tongue, in the mouth, or in the throat

Recurring yeast infections

Pneumonia

Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids

Numbness or pain in the hands or feet

Loss of muscle control and reflex, paralysis, or loss of muscular strength

Memory loss, depression, and other neurological disorders.

Because these symptoms can take years to manifest, their absence is not an indicator of HIV status. Only a medical provider can diagnose AIDS based on specific criteria established by the CDC.

How soon after exposure to HIV will symptoms appear?

For people who are not taking medication to treat HIV, more persistent or severe symptoms may not surface for 10 years or more after HIV first enters the body in adults, and within 2 years in children born with HIV. This period of "asymptomatic" infection is variable and can depend on many factors, including a person's health status and their health-related behaviors. Some people may begin to have symptoms in as soon as a few months, whereas others may be symptom-free for more than 10 years. People who are consistently and correctly taking medicine to treat HIV may stay in an asymptomatic period indefinitely.

During the asymptomatic period, however, if someone is not taking medication, HIV is actively infecting and killing cells of the immune system. HIV's effect is seen most obviously by measuring the levels of T cells in the blood -- the immune system's key infection fighters. The virus initially disables or destroys these cells without causing symptoms.

It is important to remember that it is possible to transmit HIV during this asymptomatic phase. However, people who are taking HIV treatment medication consistently and correctly and therefore have a very low level of virus in their blood are much less likely to transmit HIV.

How is it diagnosed?

HIV
The tests commonly used to detect HIV infection look for the presence of antibodies that fight HIV. The length of time between infection and when there are enough antibodies to be detected by the HIV test is often called the "window period." According to the CDC, while almost all people infected with HIV (99%) develop detectable antibodies against the virus within 3 months of infection, it is still possible that the window period is longer, However, CDC studies indicate that it is highly unlikely that HIV infection would go unrecognized for over 6 months in persons who are infected. If an HIV test is negative 3 months after a high risk experience, an individual should consult their medical provider to determine if the test should be repeated.

Health Services offers the Rapid Oral HIV test for Brown students, free of charge. This sensitive screening test, called Oraquick, detects HIV antibodies through an oral swab sample; therefore, no blood needs to be drawn. Students can expect their results in about 20 minutes. You can learn more about HIV testing, and rapid testing in particular, by viewing this 10 minute video developed by the Brown University AIDS Program.

You can make an appointment at Health Services by calling 401.863-3953. On weekdays when classes are in session, you can also walk in for HIV testing at any time between 10am and 4pm, no appointment needed.

There are other testing sites in Providence and RI that can be accessed by clicking here for locations and phone numbers. Note that the types of tests offered at these sites can differ. Depending on the type, tests may require an oral swab or a blood sample, and results may be available quickly (in under an hour) or may not be available for a period of days. You can ask the clinic which testing options they offer.

AIDS
An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses and having a t-cell count below 200. However, studies have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for noticeable AIDS symptoms to develop. So an HIV infected person who has not had any serious illnesses can receive an AIDS diagnosis on the basis of certain blood tests (T cell counts). The loss of T cells in people with HIV is a very strong predictor of the development of AIDS.

What is the difference between confidential and anonymous testing?

Confidential testing for STIs, including HIV, means that the test results will be part of your medical record. This information cannot be accessed by anyone other than you and your medical providers unless you give written permission to release your information.

Anonymous testing means that you never provide your name. You are given a number or a code and this is the only identifier which is linked with your test or your results.

What should I do if I test positive for HIV?

Consult a medical provider experienced in treating HIV/AIDS. Discuss the use of anti-viral therapies to slow the progress of the infection and to greatly reduce the chance of transmitting the virus to others.

Protect your sex partner(s) from HIV by taking your anti-viral medication as prescribed and abstaining from sex or by practicing safer sex.

Inform past and current sex partner(s) so that they can get tested.

Do not share needles or works (injection equipment).

Get psychological support with a therapist and/or join a support group for people with HIV.

Get information and social and legal support from AIDS service organizations.

Maintain a strong immune system with a healthy lifestyle and regular medical exams.

Always inform medical providers so that you can receive appropriate care.

How is an HIV infection treated?

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. They are called anti-retroviral drugs because they attack HIV, which is a retrovirus. Once inside the cell, HIV uses specific enzymes to survive. Anti-retroviral drugs work by interfering with the virus' ability to use these enzymes. They fall into two categories:

Reverse transcriptase inhibitors interfere with an enzyme called reverse transcriptase (RT) that HIV needs to make copies of itself.

In addition to the anti-retroviral drugs, there are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care. Unfortunately, the drugs currently available cannot cure an HIV infection. HIV can become resistant to any one drug and even a combination of drugs cannot suppress the virus indefinitely. However, scientists continue to develop new drugs and treatments that are helping many people infected with HIV live longer and healthier lives.